There has been increasing recognition that many children with ADHD exhibit depressive and manic-like symptoms that produce substantial impairment across several functional domains. The diagnostic and prognostic implications of these mood symptoms in ADHD children have become a major clinical controversy, with some considering them to be evidence of early onset Bipolar Disorder (BP). Our preliminary work has found that these children are more impaired than those with uncomplicated ADHD, at increased risk for developing depression and BP, have elevated rates of familial mood disorders and respond positively to traditional ADHD treatments but need additional treatments to achieve optimal functioning. The pharmacological management of children with ADHD plus impairments in mood (AIM) is a clinical dilemma as little is known about the safety of stimulants in children with manic symptoms, and it is difficult to justify the use of mood stabilizers or antipsychotics in children without clear manic episodes. Psychosocial interventions hold particular promise for children with AIM as they are well studied, pediatric treatments with little risk of worsening mood symptoms. A psychosocial treatment that targets ADHD and mood symptoms, while conjointly addressing affective symptoms in the parents, can be combined with medications and easily administered to children and families would be an ideal treatment for AIM. We propose to develop an integrative psychosocial treatment that combines aspects of behavior modification programs for ADHD with cognitive-behavioral and psychoeducation techniques for pediatric and adult mood disorders. This novel therapy combined with stimulant medication will be compared to standard ADHD treatment (stimulants) under controlled settings in children with ADHD and impaired mood (AIM). This study will also assess the efficacy and tolerability of stimulants in mood labile youth. The novel therapy holds substantial public health benefit as it will be the one the first to systematically target both internalizing and externalizing symptoms in children with ADHD and represents one of the few multimodal intervention studies for children with possible bipolar spectrum illness. The results are intended to serve as preliminary investigations into the development of multimodal interventions for children with ADHD and BP and the long term outcomes of ADHD youth with early onset mood symptoms.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
7R34MH080791-04
Application #
8110960
Study Section
Special Emphasis Panel (ZMH1-ERB-M (02))
Program Officer
Sarampote, Christopher S
Project Start
2008-04-01
Project End
2012-02-28
Budget Start
2010-07-01
Budget End
2012-02-28
Support Year
4
Fiscal Year
2010
Total Cost
$150,996
Indirect Cost
Name
Florida International University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
071298814
City
Miami
State
FL
Country
United States
Zip Code
33199
Waxmonsky, James G; Waschbusch, Daniel A; Belin, Peter et al. (2016) A Randomized Clinical Trial of an Integrative Group Therapy for Children With Severe Mood Dysregulation. J Am Acad Child Adolesc Psychiatry 55:196-207
Lu, Xi; Nahum-Shani, Inbal; Kasari, Connie et al. (2016) Comparing dynamic treatment regimes using repeated-measures outcomes: modeling considerations in SMART studies. Stat Med 35:1595-615
Rosch, Keri S; Fosco, Whitney D; Pelham Jr, William E et al. (2016) Reinforcement and Stimulant Medication Ameliorate Deficient Response Inhibition in Children with Attention-Deficit/Hyperactivity Disorder. J Abnorm Child Psychol 44:309-21
Baweja, Raman; Belin, Peter J; Humphrey, Hugh H et al. (2016) The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder Across Home and School. J Child Adolesc Psychopharmacol 26:154-63
Sibley, Margaret H; Waxmonsky, James G; Robb, Jessica A et al. (2013) Implications of changes for the field: ADHD. J Learn Disabil 46:34-42
Waxmonsky, James G; Wymbs, Fran A; Pariseau, Meaghan E et al. (2013) A novel group therapy for children with ADHD and severe mood dysregulation. J Atten Disord 17:527-41
Sibley, Margaret H; Smith, Bradley H; Evans, Steven W et al. (2012) Treatment response to an intensive summer treatment program for adolescents with ADHD. J Atten Disord 16:443-8
King, Sara; Waschbusch, Daniel A (2010) Aggression in children with attention-deficit/hyperactivity disorder. Expert Rev Neurother 10:1581-94
King, Sara; Waschbusch, Daniel A; Pelham Jr, William E et al. (2009) Social information processing in elementary-school aged children with ADHD: medication effects and comparisons with typical children. J Abnorm Child Psychol 37:579-89
Waschbusch, Daniel A; Pelham Jr, William E; Waxmonsky, James et al. (2009) Are there placebo effects in the medication treatment of children with attention-deficit hyperactivity disorder? J Dev Behav Pediatr 30:158-68

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